1164622155 NPI number — DR. CORETTA JOANNA RHODA HAMLIN M. D

Table of content: DR. CORETTA JOANNA RHODA HAMLIN M. D (NPI 1164622155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164622155 NPI number — DR. CORETTA JOANNA RHODA HAMLIN M. D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMLIN
Provider First Name:
CORETTA
Provider Middle Name:
JOANNA RHODA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M. D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164622155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2175 ROSALINE AVE FL 4
Provider Second Line Business Mailing Address:
CEP HOSPITALIST GROUP
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96001-2549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-225-7799
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2175 ROSALINE AVE FL 4
Provider Second Line Business Practice Location Address:
CEP HOSPITALIST GROUP
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-225-7799
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A100276 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: A100276 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: A100276 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ31887Z . This is a "SITE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".